不可手术结直肠癌肝转移瘤二程放疗疗效和安全性分析

Effectiveness and safety of the second-course radiotherapy for unresectable colorectal cancer liver metastases

目的分析不可手术结直肠癌肝转移瘤接受二程放疗的疗效和安全性。方法回顾性收集2017—2023年于北京大学肿瘤医院接受二程放疗的28例不可手术结直肠癌肝转移患者的资料,分析二程放疗的可行性。结果28例患者二程放疗后中位随访时间为20.2个月。二程放疗距首程放疗的中位时间为11.1个月。首程放疗和二程放疗的中位生物有效剂量(BED)分别为100和96 Gy,分别有25例(89.3%)和24例(85.7%)患者接受了体部立体定向放射治疗。首程放疗和二程放疗的正常肝脏平均受量的2 Gy分次的等效剂量(EQD2)分别为10.1和7.9 Gy。二程放疗后的完全缓解率和部分缓解率分别为54.5%和18.2%,客观反应率为72.7%。二程放疗后基于患者的2年的累积局部失败率为17.0%,基于病灶的2年的累积局部失败率为15.1%,1年无进展生存(PFS)为27.4%,3年总生存(OS)为46.7%。二程放疗后患者的耐受性良好,大部分患者(75.0%)出现1~2级急性不良反应,只有1例(3.6%)患者出现3级急性不良反应。结论对于不可手术结直肠癌肝转移患者,二程放疗安全有效。

ObjectiveTo analyze the effectiveness and safety of the second course radiotherapy for unresectable colorectal cancer liver metastases.MethodsWe retrospectively collected the data of 28 patients with unresectable colorectal cancer liver metastases who received the second course radiotherapy at Peking University Cancer Hospital and Institute from 2017 to 2023,to analyze the feasibility of re-irradiation.ResultsFor the 28 patients,the median follow-up time after re-irradiation was 20.2 months.The median time interval between the first-and second-course radiotherapy was 11.1 months.The median biologically effective doses of the first-and second-course radiotherapy were 100 Gy and 96 Gy,respectively.Stereotactic body radiotherapy was administered to 25 patients(89.3%)during the first course and 24 patients(85.7%)during the second course of radiotherapy.The mean equivalent dose in 2 Gy fractions to the normal liver was 10.1 Gy in the first-course radiotherapy and 7.9 Gy in the second-course radiotherapy.The complete response rate,partial response rate,and objective response rate after re-irradiation were 54.5%,18.2%,and 72.7%,respectively.After re-irradiation,the 2-year cumulative local failure rate was 17.0%when calculated based on patients and 15.1%when calculated based on lesions,the 1-year progression-free survival rate was 27.4%,and the 3-year overall survival rate was 46.7%.The second-course radiotherapy was well tolerated,with most patients(75.0%)experiencing grade 1-2 acute adverse reactions and only one case(3.6%)experiencing grade 3 acute adverse events.ConclusionsSecond course radiotherapy is an effective and safe treatment approach for selected patients with unresectable colorectal cancer liver metastases.